Prenatal depression has been associated with adverse neonatal outcomes including preterm birth and low birth weight. Potential underlying mechanisms for prenatal depression effects on prematurity and low birth weight are elevated norepinephrine and cortisol noted in depressed pregnant women. These may lead to increased uterine artery resistance and the resulting limited blood flow, oxygen and nutrients to the fetus. Moderate pressure massage therapy may reduce this problem in depressed pregnant women by neither decreasing norepinephrine, resulting in decreased uterine artery resistance, increased oxygen and nutrients to the fetus and lower prematurity and low birth weight. An alternative model being explored here is that moderate pressure massage may increase progesterone/estriol ratios which counteract the negative cortical effects on gestational age. Eighty pregnant women with depression symptoms will be recruited at approximately 20 weeks gestation and randomly assigned to a moderate pressure massage therapy or to a SHAM light pressure massage touch/attention control group. The women will receive 20-minute weekly massage therapy sessions from 20 to 32 weeks gestation. At 20 and 32 weeks gestation, depressed symptoms will be assessed using the BDI, and norepinephrine, cortical, progesterone and estriol levels will be assayed from urine samples. Maternal Dopple ultrasound will be conducted to assess the uterine artery resistance index as an estimate of uterine artery blood flow. Upon delivery, the mothers'medical charts will be reviewed to record gestational age and birth weight. We are hypothesizing that the moderate pressure massage group will show increased progesterone/estriol ratios and decreased norepinephrine, cortical, uterine artery resistance, prematurity and low birth weight. The models we are exploring are that 1) decreased norepinephrine following moderate pressure massage mediates the massage effects on reduced uterine artery resistance and/or 2) moderate pressure massage leads to increased progesterone/estriol ratios leading to lower cortical and uterine artery resistance and 3) both pathways lead to a lower incidence of prematurity and low birth weight. This model will be tested by structural equations analysis. PUBLIC HEALTH RELEVANCE: This project will investigate the effects of massage therapy on depressed pregnant women. We would expect the massage therapy would reduce intrauterine artery resistance, prematurity and low birth weight.